Food security and eating disorder behaviors in the International Food Policy Study, 2018 to 2022

A link has been established between food insecurity and eating disorder (ED) pathology, but most research on this topic has occurred in the USA. This study examined associations and potential moderators of associations between food security (FS) levels and ED behaviors cross-nationally.

Repeated cross-sectional data representing 104 881 adults 18-100 years of age in Australia, Canada, Mexico, the UK, and the USA came from five waves (2018-22) of the International Food Policy Study. Participants completed the Household Food Security Survey Module and reported on past-3-month binge eating and self-induced vomiting to control weight. Associations between past-year household FS level and ED behaviors were examined with adjusted modified Poisson regression models. Interactions with potential moderators were also tested.

Marginal, low, and very low FS were associated with elevated prevalence of both ED behaviors. Compared with households with high FS, binge eating was 1.34, 1.54, and 1.73 times as prevalent in households with marginal, low, and very low FS, respectively. Associations were stronger for self-induced vomiting; compared with households with high FS, self-induced vomiting was 2.40, 7.10, and 11.98 times as prevalent in households with marginal, low, and very low FS, respectively. Moderation results revealed meaningful differences by some factors. For example, associations were weaker in Mexico and stronger among ethnic minorities and participants with children.

Results support cross-sectional associations between FS and ED behaviors, with a particularly strong link for self-induced vomiting. Some heterogeneity in these associations was observed across country and sociodemographic factors.